Orange County NC Website
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DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Home <br /> Email address Home Phone Mobile address Affiliation <br /> 1605 Nature <br /> Fountain Conservancy <br /> Mike Ridge Road, <br /> Andrews mikeandrewsnc(c�amail.c Chapel Hill, <br /> (Treasurer) om 919-949-6936 NC 27517 <br /> 1510 Livia Physical <br /> Susan Drive, Therapist <br /> Attermeier Hillsborough, <br /> (Secretary) satter(a�bellsouth.net 919-929-9533 919-414-3932 NC 27278 <br /> 1602 Retired, Duke <br /> Claymore University <br /> Road, <br /> Chapel Hill, <br /> John Barrow lohnbarrow(c�nc.rr.com 919-818-0226 NC 27516 <br /> 301 Purefoy TetraTech <br /> Kimberly Road, <br /> Brewer(Vice kimberly(c�oranciecountyli Chapel Hill, <br /> Chair) vinawaae.orq 919-968-4251 919-357-2122 NC 27514 <br /> Retired, Cecil G. <br /> Sheps Center <br /> 910 Emory for Health <br /> Drive, Services <br /> Victoria Chapel Hill Research, UNC- <br /> Freeman freevictoria ,gmail.com 919-942-0669 919-636-8765 NC 27517 Chapel Hill <br /> 165 Retired, <br /> Viburnum Research & <br /> Way, Evaluation <br /> steve @orangecountylivin Carrboro, NC Associates <br /> Steve Jenks gwage.org 919-942-9452 27510 <br /> 6329 U.S. Department <br /> Cardinaux of Agriculture <br /> Lane, Holly <br /> Springs, NC <br /> Chris Lathrop chris @lathrop.com (910)551-9378 27540 <br /> 7207 Marcoplos <br /> Southern Construction <br /> Trail, Chapel <br /> Mark Hill, NC <br /> Marcoplos marcoplos(c.bellsouth.net 919-524-6287 27516 <br /> 218 Lake N/A <br /> Susan Manor Road, <br /> Romaine susan(c�orangecountylivin Chapel Hill, <br /> (Chair) gwage.orq 919-619-3408 NC 27516 <br /> g) Solid Waste Program Fee (SWPF) Verification <br /> This fee finances Orange County's recycling and waste reduction program. Submit either a.) <br /> proof of payment of the agency's FY 2016-17 Solid Waste Program Fee, OR b.) a statement <br /> on agency letter head indicating exemption and specify the person(s), business, etc. that is <br /> responsible for paying this fee. <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMP age 31 1r 32 <br />